Thursday, July 10, 2008

it's a brutal cycle

I'm having a hard time empathizing with people who come into detox who really aren't interested in breaking the cycle of addiction. I mean I get it, and I don't. Of course, the first question you're probably asking while reading this is "well why are they in detox if they don't want to get clean?" That at least, I can explain.

At work we definitely work towards harm reduction. And I'm all for that. I really am, and that's the thing with detox; harm reduction. We encourage some of our regulars (or any/all of them) to come into detox to give their bodies a 10 day break for the realities of their addictions and street life. The get a bed to sleep in, nutrious food, milk and their meds on time each day. At any given time we have a couple of our regulars in their doing this. And some of them do move on to periods of sobriety. I haven't been there long enough to know if we've ever seen anyone do a complete one eighty and wide up a working individual with an apartment, phone, and cable.

Now a lot of our regulars are older, and have been doing this for a long time. Many of them have brains which either started out damaged (FASD, PDD, etc...) or have been damaged through use of drugs, alcohol and solvents. Drinking hairspray has long lasting consequences! I have a fairly easy time empathizing with them. Whatever their initial reasons for winding up on the street were, they've lived a hard life, and I really feel for them. I feel like we need to protect them.

But then, we have some younger people, people my age and a little bit older. People with SO much potential. Their brains haven't yet been destroyed, they're literate and able to function (in some cases at least), but they have no desire to stop the drugs and get off the streets. That, I have a hard time with. I just don't get it. How can you WANT to live on a mat, on the floor, sniff solvents, and wind up passed out in random places. One guy came in because he badly hurt himself while high/drunk/out of it, and was in danger of losing his leg from an infection. Once his leg was better, off he went. Harm reduction though. He's pretty sure he's going to stop injecting things and stick with sniffing and drinking.

Thinking about it in terms of the stages of changes helps. This guy is in precontemplation, and that's okay. People go through precontemplation before they go through other stages. It's the way it works. And there are things we can use with precontemplation. I've been using a lot of motivational interviewing in cases like this, latching onto people's ambivilence, reflecting back the bad things about use (but not neglecting the good things), providing information, and having an unwavering belief that the person can change (which reminds me, I should post about that). It's the empathy I have a hard time with. And I'm not sure it's going to get any easier...

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